Pre-emptive administration of fibrinogen concentrate contributes to improved prognosis in patients with severe trauma

作者：Koji Yamamoto, Atsushi Yamaguchi, Makoto Sawano, Masaki Matsuda, Masahiro Anan, Koichi Inokuchi, Satoru Sugiyama · 发表于：Trauma Surgery & Acute Care Open · 年份：2016 · DOI：10.1136/tsaco-2016-000037 · 被引用次数：37 · 研究领域：Trauma, Hemostasis, Coagulopathy, Resuscitation、Hemostasis and retained surgical items、Abdominal Trauma and Injuries

BACKGROUND: Patients with severe trauma often present with critical coagulopathy, resulting in impaired hemostasis, massive hemorrhage, and a poor survival prognosis. The efficacy of hemostatic resuscitation in correcting coagulopathy and restoring tissue perfusion has not been studied. We assessed a novel approach of pre-emptive administration of fibrinogen concentrate to improve critical coagulopathy in patients with severe trauma. METHODS: We retrospectively compared blood transfusion volumes and survival prognosis between three groups of patients with trauma, with an Injury Severity Score (ISS) ≥26 over three consecutive periods: group A, no administration of fibrinogen concentrate; group B, administration of 3 g of fibrinogen concentrate after evaluation of trauma severity and a plasma fibrinogen level <1.5 g/L; group C, pre-emptive administration of 3 g of fibrinogen concentrate immediately on patient arrival based on prehospital information, including high-severity injury or assessed need for massive transfusion before measurement of fibrinogen. RESULTS: ∼56% of patients with an ISS ≥26 and transfused with red blood cell concentrates ≥10 units, had hypofibrinogenemia (fibrinogen <1.5 g/L) on arrival. Patients who received fibrinogen concentrate in group C showed significantly higher fibrinogen levels after treatment with this agent than those in group B (2.41 g/L vs 1.88 g/L; p=0.01). Although no significant difference was observed in blood transfusion volumes between ...